Looking back on what you’ve learned from previous mission experiences, what are some strengths you feel that you can bring to this mission team?

Please Explain:
*

Passport Requirements

Citizen, Status & Name required for all trips; other fields required for international trips only, and can be submitted later using Passport Update form if necessary

Are you a US Citizen?
*

Passport Status:
*

N/A(Domestic Trip) Have Passport Applied for Passport Have not Applied for Passport

If you have a passport, please enter your details below:

Full Legal Name (as on Passport/DL)

Passport Number:

Expiration Date:

Redress #:

Participation Policy

By participating in a mission trip through Madison Academy, you are awarded an amazing opportunity to serve alongside students, faculty, staff and alumni in various locations across the country and around the world. Please carefully review the statements below; by checking the boxes below, you understand and agree to the following:

* I will submit my deposit as applicable to me within two weeks. My deposit and any donations made towards my trip are NON-REFUNDABLE.

* I am responsible for the entire financial balance associated with my trip, even if I cancel my participation.

* I will attend and participate in team meetings.

I understand that failure to abide by these policies will result in my dismissal from the team prior to departure or being sent home at my own expense, a hold may be placed on my account, and disciplinary action may be taken by Madison Academy when applicable.

Medical

I have provided complete and accurate information regarding my medical history, both current and past, in the Medical History section of this form.

There are no health-related reasons (emotional, mental or physical) that prevent or affect my participation in this trip.

I understand that I am responsible for my personal medical needs including insurance, medication, immunizations, and costs associated with destination-specific preventative care, treatment, or hospitalization

I agree to grant my team leaders the power and permission to make any emergency healthcare decisions that may arise (medical power of attorney). I understand that no responsibility is assumed for any injury, damage or expense that may arise from such decisions.

Disclaimer of Responsibility

I understand there are certain dangers, hazards, and risks inherent in domestic & international travel. The parties listed above are not responsible for any personal injuries or property damage that may occur.

Madison Academy is not responsible for injuries, losses, or expenses resulting from circumstances within a trip, including but not limited to the actions of service suppliers (transportation carriers, hotels, government officials, etc), disruption of travel arrangements, weather, and civil/political unrest.

Madion Academy reserves the right to cancel, postpone or modify a trip as deemed necessary by the administration.

We have read the above list of preparation requirements for Madison Academy’s Baja Missions Team and we understand that much is expected of us. If we are granted admission to the team, we will commit to completely fulfill every requirement before we are allowed to make the trip. Also, we know that as an ambassador of Jesus Christ and the Madison Academy, we are expected to be a Christ-like example and a influence for good. We take these expectations seriously and realize the responsibility entrusted in each team member.

I agree to obey and abide by all rules, regulations, and requirements set forth by the Baja leadership team.

If for some reason I am unable to complete all the requirements, I understand that I will forfeit my space on the team for this year and my deposit will be non-refundable.

As an agreement to the above statements, I sign my name as a pledge that I understand what is expected of me and as a pledge to give the best of myself to these efforts. I understand this is a team effort.

Cost, including deposit, per person: $1,100. I have enclosed a deposit check for $100.00 payable to Madison Academy, with the name of the participant and "Baja" in the memo field.

TERMS OF ACCEPTANCE and SIGNATURE

I, the [applicant, requestor, etc.] for this [type of form], warrant the truthfulness of the information provided in this application.

Please type your First and Last Name

Student E-Signature:
*

Please type your First and Last Name

Parent E-Signature
*

Deposit

I would like to submit deposit online:
*

Please submit deposit check of $100.00 to Andy Blackston no later than October 1, 2017.

Please make checks payable to Madison Academy. In the memo line write the name of the participant - Baja.